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Related Experiment Videos

A not so simple analgesic.

Sarah Howie1, Anne Tarn1, Charles Soper1

  • 1Renal Office , Mayday University Hospital , London Road, Thornton Heath, CR7 7YE, UK.

NDT Plus
|May 8, 2015
PubMed
Summary
This summary is machine-generated.

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Pyroglutamic acidosis, a rare cause of high anion gap metabolic acidosis, is underdiagnosed. Chronic paracetamol use can precipitate this condition, as seen in a pregnant woman requiring intensive care.

Area of Science:

  • Biochemistry
  • Internal Medicine
  • Critical Care Medicine

Background:

  • High anion gap metabolic acidosis has common, well-recognized causes.
  • Pyroglutamic acidosis (5-oxoproline acidosis) is an underdiagnosed cause.
  • Underdiagnosis stems from limited laboratory availability and low physician awareness.

Observation:

  • Chronic paracetamol use is a frequent precipitant.
  • Paracetamol is increasingly prescribed, often at maximal doses.
  • A case of severe pyroglutamic acidosis in a pregnant woman is presented.

Findings:

  • The patient developed severe metabolic acidosis due to elevated pyroglutamate.
  • Treatment required emergency Cesarean section, ventilation, and haemodiafiltration.
Keywords:
acidosisanion gapoxoprolineparacetamolpyroglutamate

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  • Normal renal function was noted despite the severity of acidosis.

    • Implications:

    • Increased awareness of pyroglutamic acidosis is crucial for timely diagnosis.
    • Clinicians should consider pyroglutamic acidosis in patients with unexplained high anion gap metabolic acidosis, especially with paracetamol use.
    • Identifying other risk factors is important for managing this condition.